While compassion is widely recognised as an essential component of high-quality patient care, the compassion needs of clinicians often go unrecognised and unmet. Clinicians face multifaceted sources of workplace suffering, both sources inherent to working with the sick and avoidable sources due to healthcare systems and leadership challenges. Organisational compassion, defined as the continuous and systematic identification, prevention and alleviation of sources of suffering for healthcare workers, offers a paradigm shift in mitigating and preventing clinician suffering and burnout. Yet little is known about how clinicians experience suffering and compassion from their organisations, teams and leaders.

Our overarching goal is to develop a clinician-reported experience measure of organisational compassion. The purpose of this study was to explore how clinicians experience suffering and compassion in healthcare organisations.

This qualitative study used semistructured interviews of interdisciplinary paediatric hospice and palliative care clinicians from across the USA. A moderator’s guide was developed based on the literature of organisational compassion in management and healthcare and validated through practice interviews with clinicians. 22 participants were recruited via national paediatric hospice and palliative care email list serves. Video interviews were conducted via Zoom. Transcripts were analysed using a hybrid grounded theory-thematic analysis methodology to identify themes and to construct a theoretical framework of compassion experiences.

Five major themes of experiencing compassion emerged: (1) Feeling cared about, characterised by authentic, empathetic responses to clinician distress; (2) Dignity, encompassing being valued, respected and recognised as a whole person and professional; (3) Proximal (team) compassion, including camaraderie, shared workload and mutual support within teams; (4) Structural (organisational) compassion, reflecting policies, practices and benefits that alleviate or exacerbate suffering and (5) Compassionate leadership behaviours, such as presence, empathy and connection to frontline staff needs.

Healthcare work includes sources of both inherent and avoidable suffering for clinicians. In this study, we sought to understand how clinicians experience compassion from their organisations, leaders and team members during times of distress. We found five themes of experiencing compassion in healthcare organisations: feeling cared about; dignity; proximal (team) compassion; structural (organisational) compassion and compassionate leadership behaviours. These qualitative data and results will provide an empiric foundation for the development of a clinician-reported experience measure of compassion for use in healthcare settings. Such a measure will enable future research examining how compassion experiences in healthcare may predict workforce outcomes such as burnout, satisfaction, engagement and thriving. Ultimately, this work may support the design of interventions aimed at strengthening compassionate organisational cultures and improving conditions for the healthcare workforce and both experiences and outcomes of the patients they serve.

As populations age and climate variability intensifies, seasonal migration has emerged as a strategy among older adults to reduce exposure to climatic extremes and optimise living conditions. In China, millions of older adults migrate annually between cold northern and tropical southern regions, providing a natural setting to examine the health effects of seasonal migration. The Frigid-Tropical Migratory Population Health (ftMPH) cohort was established to assess the short- and long-term health effects of this migration and the underlying biological, behavioural and social pathways.

The ftMPH cohort is a prospective, dynamic cohort jointly conducted in Heilongjiang (a cold region) and Hainan (a tropical region) in China, with a planned sample size of approximately 26 000 participants. Adults aged ≥60 years are recruited and classified into four subcohorts: cold-origin seasonal migrants, cold-region residents, tropical-origin seasonal migrants and tropical-region residents. Baseline assessments include questionnaires, clinical examinations, biospecimen collection and environmental exposure measurements. Each migration cycle is assessed at predefined time points spanning the departure and return phases. Migration exposure will be updated longitudinally at each follow-up interval.

The primary outcome is the incidence of major cardiovascular disease events, including non-fatal myocardial infarction, coronary revascularisation, stroke and cardiovascular mortality. Secondary outcomes include non-cardiovascular mortality, chronic disease events, healthcare utilisation and ageing-related measures. Time-to-event analyses will be performed using Cox proportional hazards models. Inverse probability of treatment weighting (IPTW) will be used to control for baseline confounding, with stabilised weights and covariate balance assessed using standardised mean differences. Longitudinal changes in repeated measures will be analysed using mixed-effects models.

Ethical approval was obtained from the Ethics Review Committee of Harbin Medical University (approval No HMUIRB2024029PRE) and the Ethics Review Committee of Hainan Medical University (approval No HYMLL-2025-102). Findings will be disseminated through peer-reviewed publications, conference presentations and policy or technical reports.

The ftMPH cohort is registered with the Chinese Clinical Trial Registry (ChiCTR2500102337; registered on 13 May 2025).

Weight stigma and internalised weight bias are associated with poor mental, social and physical health. Weight-neutral approaches prioritise well-being and sustainable health behaviours. However, the feasibility and acceptability of weight-neutral interventions remain uncertain.

Weight-Neutral Health Intervention (WIN) is an investigator-initiated single-arm feasibility study enrolling 56 adults with body mass index ≥30 kg/m² in the Capital Region of Denmark. The study investigates a codesigned weight-neutral health intervention. The 6-month intervention comprises 1 preparatory session and 11 group sessions led by trained practitioners, focusing on intuitive eating, body acceptance and self-compassion; optional components include support-network events, up to three individual online sessions and access to ‘size-inclusive yoga’ and ‘body competence’ courses. The primary feasibility outcome is follow-up completion. Recruitment proportion and adherence are secondary feasibility outcomes. These will be assessed using a set of predefined ‘traffic-light’ stop/go progression criteria. Exploratory feasibility outcomes include data completeness for other outcomes and participant engagement with the intervention. Exploratory clinical outcomes include questionnaire data (quality of life, depression, weight bias internalisation, eating behaviours, self-esteem, body image, stress and life satisfaction), clinical measures (weight, heart rate and blood pressure), biomarkers (blood samples and hair cortisol), 7-day actigraphy (physical activity and sleep) and serious adverse events. Qualitative interviews, focus groups and fieldnotes will be used to explore acceptability and contextual factors. If progression criteria are met, the study will inform the design of a pragmatic, multicentre, randomised trial. The exploratory outcomes will inform outcome selection, setting, sample size and procedures.

Approved by the Regional Ethics Committee of the Capital Region of Denmark (H-25013213). Results will be disseminated through peer-reviewed publications, conferences and public platforms.

NCT06922630.

Effective treatment for clinical obesity is available but is rarely offered by healthcare systems, which often treat complications without treating the underlying cause. The LightWAY trial will investigate the clinical benefits and harms as well as cost-effectiveness of an intensive weight loss intervention compared with existing weight management programmes for people with clinical obesity.

LightWAY is an investigator-initiated, international, randomised, parallel-group clinical superiority trial with blinded outcome assessment. Six hundred people seeking treatment for clinical obesity (body mass index ≥35 kg/m² with comorbidities) will be recruited in centres in the UK and Denmark and randomised 1:1 to one of two groups. The experimental group will be offered a 2-year intensive weight loss programme providing support and advice to follow a total diet replacement programme, followed by gradual transition to an energy-reduced diet in combination with increased physical activity and if needed, prescription of weight loss medication. The control group will receive usual care, typically comprising brief behavioural support for weight loss and treatment of the complications of obesity or occasionally referral to specialist weight management services. The two co-primary outcomes are cardiometabolic risk, assessed with metabolic syndrome severity Z-score, and body weight assessed at 2 years. The secondary outcomes include the Short Form-36 mental component scale, 4-metre gait speed and proportion of participants achieving ≥20% weight loss. The key adverse effects will be the proportion of participants with at least one serious adverse event, incidence of eating disorders and disproportional loss of bone mass. Incremental cost-effectiveness will be assessed over the trial period and over the lifetime through modelling.

Ethical approval was granted in the UK (August 2024, 24/SC/0211) and Denmark (December 2023, H-23065222). Findings will be disseminated through peer-reviewed journals and scientific conferences and to participants in the trial and clinicians.

NCT06321458.

To investigate the impact of early-life human rhinovirus (HRV) and respiratory syncytial virus (RSV) infections on subsequent asthma development among children with acute respiratory infections (ARI), with a focus on the timing of infection during critical developmental windows.

Retrospective cohort study.

Tertiary paediatric hospital—Children’s Hospital of Soochow University in eastern China—with data linked to a regional health information system.

A total of 2628 children who were hospitalised with acute respiratory infections (ARI) and received respiratory virus testing between September 2017 and December 2024 were included in this study.

The primary outcome was incident asthma. Associations between early-life HRV or RSV infection and asthma risk were evaluated using univariate and multivariable Cox proportional hazards models. Causal mediation analysis was applied to examine potential mediation by wheezing and bronchiolitis. Secondary outcomes were the frequency of asthma-related medical visits and number of exacerbations, analysed using multivariable negative binomial regression models.

Overall, 616 (20.2%) children developed asthma. Cox regression showed that HRV-RSV (aHR=2.40, 95% CI 1.02 to 6.69) and s-HRV (aHR=1.56, 95% CI 1.10 to 2.22) were associated with asthma risk compared with negative controls, whereas s-RSV was not (aHR=1.31, 95% CI 0.89 to 1.89). Wheezing mediated 53.5% of the effect of HRV on asthma risk. Among asthma cases, both HRV and RSV were associated with increased asthma-related visits and exacerbations.

Early-life hospitalisation for HRV or RSV, particularly at 13–24 months of age, may be associated with increased risk of asthma and greater asthma morbidity. These findings suggest a potential role of infection timing in shaping long-term respiratory outcomes.

To examine how household members, community health research workers (CHRWs) and broader social networks influenced pregnant women’s capabilities, opportunities and motivations to consume a daily balanced-energy protein (BEP) supplement or a multiple micronutrient supplement (MMS) in the context of an effectiveness trial in rural Bangladesh.

In-depth interviews, group interviews, focus group discussions, thematic analysis using the Capability, Opportunity, Motivation-Behaviour (COM-B) framework.

Gaibandha, Bangladesh.

Women (n=32) who had completed participation in the TARGET-BEP randomised trial, their husbands (n=13) and mothers-in-law (n=13), who participated in 13 group interviews, and CHRWs (n=39) who participated in six focus group discussions.

Capability to adhere to BEP and MMS was strengthened when family members understood the value of supplements and actively supported supplementation. Children emerged as unexpected facilitators, reminding mothers to consume supplements and tracking intake. Opportunity to use supplements consistently was enhanced by women’s educational attainment and the availability of household resources. Finally, motivation to take the supplements was influenced by many actors including neighbours, who could offer support but also often transmitted rumours and taboos, and CHRWs, who adeptly adapted adherence messages to the local context and to women’s specific concerns.

To improve antenatal supplement adherence and maternal–infant health in Bangladesh and similar contexts, pregnancy nutrition programmes should move beyond the woman-as-sole-agent paradigm by: (1) co-designing messages for husbands, mothers-in-law, children and neighbours in conversation with effective community health workers, such as those working in the TARGET-BEP trial; (2) equipping community health workers with flexible, family-engaging counselling strategies; and (3) complementing women’s education gains with gender-transformative and family-inclusive interventions.

ClinicalTrials.gov NCT05576207

Tinnitus is a highly prevalent and distressing symptom in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). While international clinical guidelines primarily focus on hearing recovery through pharmacological interventions, effective treatment for tinnitus remains limited. Sound therapy, such as masking and retraining therapy, has emerged as a promising treatment. This systematic review aims to evaluate the efficacy and safety of sound therapy for the alleviation of tinnitus in adult patients with ISSNHL.

Researchers will independently conduct searches for randomised controlled trials in the following databases: PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP), CNKI and Wanfang Data. The literature search is scheduled for March 2026 without language restrictions. The review will include studies involving adult patients (18 years or older) diagnosed with ISSNHL with tinnitus symptoms who underwent sound therapy (including Tinnitus Masking Therapy, Tinnitus Retraining Therapy or music therapy) with standard drug therapy, placebo or any other non-acoustic interventions compared with the same treatment alone. Researchers will independently screen studies, extract data and assess the risk of bias using the Cochrane Risk of Bias 2 tool. Data analyses will be performed using RevMan V.10.0.2 and Stata V.18.0 software. The certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

This study relies on the analysis of secondary data from previously published trials; therefore, ethical approval from a research ethics committee is not required. The results of this systematic review will be disseminated through publication in a peer-reviewed scientific journal.

PROSPERO registration number

CRD420261294173.

The predominant concern during pregnancy is musculoskeletal pain, often accompanied by additional discomforts such as anxiety and insomnia. Pilates, as a low-impact mind-body exercise, may be beneficial in managing musculoskeletal pain and associated symptoms in adults. This systematic review and meta-analysis aimed to synthesise the evidence on the effectiveness of Pilates for alleviating musculoskeletal pain and other discomforts during pregnancy.

Systematic review and meta-analysis.

PubMed, Scopus, TRIP Medical Database, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to 14 January 2026.

Randomised controlled trials and prospective non-randomised controlled studies that compared Pilates with other prenatal care modalities for improving musculoskeletal pain and discomfort were eligible.

Two researchers independently extracted data using standardised forms with subsequent cross-verification. Risk of bias was assessed using the Cochrane Risk of Bias V.2.0 tool. Meta-analyses were performed using random-effects models. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

13 studies were included in the systematic review, of which 10 contributed data to the meta-analysis. Primary outcomes were pain intensity and disability level. Pain intensity was assessed using Visual Analogue Scale (range 0–10). Moderate-certainty evidence demonstrated that Pilates significantly reduced musculoskeletal pain during pregnancy (mean differences (MD)=–2.59, 95% CI –4.19 to –1.00; I^²=91%, p=0.001). Low-certainty evidence suggested that Pilates reduced pregnancy-related disability (standardised mean differences (SMD)=–1.82, 95% CI –2.99 to –0.66; I^² = 93%, p=0.002). Secondary outcomes comprised sleep quality and psychological status. Multivariate meta-analysis showed significant improvements in psychological status (SMD=–0.86, 95% CI –1.31 to –0.42; ²=0.4, I^²=86%, p=0.0005) but did not yield statistically significant improvements in sleep quality (MD=–1.93, 95% CI –4.70 to 0.84; I^²=93%, p=0.17). Both secondary outcomes were supported by very low-certainty evidence. Risk of bias assessment rated three studies as high risk, three as unclear risk and seven as low risk. Formal assessment of publication bias was not feasible owing to the limited number of studies (fewer than 10 per outcome).

This meta-analysis demonstrates that, compared with standard care, structured prenatal Pilates significantly alleviates musculoskeletal pain and disability while also enhancing psychological status.

CRD42024628027.

The general practitioner workforce (GPWF) is an important factor influencing primary care capacity. Many countries face GP shortages and substantial challenges in workforce development. However, the factors and mechanisms shaping GPWF development remain insufficiently understood.

To explore key challenges affecting GPWF development and their interrelationships in the primary care system of Beijing, China.

Between October and December 2024, directors and GPs from 18 community health centres were recruited using purposive sampling. Data were collected through a focus group discussion and in-depth interviews; thematic analysis was conducted in line with Merriam and Tisdell’s approach. A causal loop diagram (CLD) was then developed to identify and visualise dynamic relationships among factors influencing the GPWF development.

The participants comprised 10 directors and 8 GPs from urban and suburban areas, with a predominance of women and those holding senior professional titles. Participants had diverse educational and professional backgrounds. Three major themes were identified: (1) rising demand for GP services, (2) supply challenges in the GPWF, and (3) challenges to GPs’ professional sustainability. Across these themes, 12 subthemes and 10 key variables were identified. The CLD reflected participants’ perceptions of how these variables interacted and illustrated potential reinforcing interactions among them.

The development of the GPWF in Beijing is constrained by multiple interrelated challenges. Addressing these challenges entails coordinated policy actions to strengthen workforce planning and training, enhance job attractiveness, improve the alignment between training and practice, and reinforce professional support and continuing professional development, thereby promoting the sustainability of the GPWF.

Respiratory syncytial virus (RSV) is a significant cause of respiratory infections in young children. Since 2021, RSV has been a notifiable disease in Australia. However, current surveillance systems focus on hospitalised RSV, with limited surveillance at a community level through primary care clinics. This approach only captures RSV requiring hospitalisation. Less severe illnesses, while not captured, may have significant social and economic impacts including the associated cost of care and absenteeism. The aim of this study is to establish an understanding of the broader burden of RSV in young children in a community setting.

The PATROL (Parents Actively Tracking RSV in Little Ones) project is a prospective longitudinal observational study of RSV and other respiratory viruses in children

Incidence rates of RSV illness and asymptomatic carriage will be calculated and compared with the incidence rate ratios of other respiratory viruses.

The Government of Western Australia Child and Adolescent Health Service Human Research Ethics Committee approved all study materials. Results and findings will be disseminated through manuscripts, conference abstracts and presentations, participant newsletters and appropriate general news media items.